Advances in Diagnosis and Treatment of Heart Failure by Intestinal Microbiota

doi:10.12114/j.issn.1007-9572.2019.00.306

Abstract

Abstract: The physiological role of intestinal microbiota in non-gastrointestinal diseases has attracted growing attention of researchers, which has also been shown to be an important factor in the pathogenesis and development of heart failure.There are characteristic changes in intestinal microbiota composition in patients with heart failure, such as the increase of harmful microbiota and their metabolites, for example trimethylamine oxide（TMAO）, and the decrease of protective microbiota and their metabolites, for example short-chain fatty acids. Meanwhile, heart failure can also induce intestinal congestion, edema, and heightened permeability, allowing harmful microbiota and their toxic metabolites such as endotoxin into the circulation through the intestinal wall, which triggers cytokine generation and activates signal pathway, thereby contributing to further impairment in cardiac function. Given the importance of intestinal microbiota in the development of heart failure, it is expected that regulating intestinal microbiota and interfering with its metabolites will be a new target for the diagnosis and treatment of heart failure. The article aims to review the changes of intestinal microbial composition, the mechanism of their toxic metabolites in heart failure and the research progress in interventional intestinal microbiota in the treatment of heart failure.

Key words: Heart failure, Intestinal microbiota, Microbial metabolite, Pathogenesis, Therapy, Review

摘要： 肠道微生物在非胃肠疾病中发挥的重要生理作用逐渐引起医学界关注及重视，其亦被证实是影响心力衰竭发生、发展的重要因素。心力衰竭患者的肠道微生物组成存在特征性改变，如有害性微生物及其代谢产物氧化三甲胺（TMAO）等增多、保护性微生物及其代谢产物短链脂肪酸减少。同时，心力衰竭也可引起肠道淤血水肿、通透性增加，促使有害性微生物及其产生的内毒素、代谢产物经肠壁进入循环，从而刺激机体产生促炎性因子并通过调节相关信号通路进一步加重心力衰竭。鉴于肠道微生物在心力衰竭疾病发展过程中的重要作用，通过调节肠道微生物组成及干预其代谢产物有望成为心力衰竭诊疗的新靶点，本文将对心力衰竭时肠道微生物组成变化及其代谢产物在心力衰竭中的作用机制进行阐述，同时介绍通过干预肠道微生物治疗心力衰竭的研究进展。

关键词: 心力衰竭, 肠道微生物, 微生物代谢产物, 发病机制, 治疗, 综述

CHEN Zijun,ZHU Bin,YANG Chun, et al. Advances in Diagnosis and Treatment of Heart Failure by Intestinal Microbiota　[J]. Chinese General Practice, 2019, 22(35): 4346-4352. DOI: 10.12114/j.issn.1007-9572.2019.00.306.
陈子俊,朱滨,杨春等. 肠道微生物与心力衰竭诊治的研究进展[J]. 中国全科医学, 2019, 22(35): 4346-4352. DOI: 10.12114/j.issn.1007-9572.2019.00.306.

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